We carried out a review of the data available to us about Westminster House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Westminster House, you can give feedback on this service.
Westminster House provides all single bedrooms, suitable communal areas and access to a rear patio and garden.
We found the following examples of good practice
There were procedures in place to support safe visiting by family members or professionals. Staff undertook screening of all visitors. Rapid response lateral flow tests (LFT) were undertaken for visitors before they entered the home. Visitors were provided with Personal Protective Equipment (PPE) and guided to its safe use.
People and staff were regularly tested for COVID-19. Staff had LFT testing three times a week as well as standard Polymerase Chain Reaction (PCR) tests weekly. The registered manager understood the actions they needed to take should any tests return a positive result.
The service had a good supply of PPE to meet current and future demand. Staff were using this correctly and in accordance with current guidance and disposal was safe at the time of this inspection.
The registered manager was aware of actions they should take should a person return from a hospital admission. The home had space for people to socially distance whilst in communal areas. All bedrooms in use were for single occupancy.
The home was kept clean. Staff kept records of their cleaning schedules, which included a rolling programme of continuously cleaning high touch surfaces, such as light switches, grab rails and door handles.
Westminster House is a residential care home providing short term respite care for people with a learning disability or autism.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties however, it was in a residential area with easy access to the town centre shops and amenities. It was registered for the support of up to 10 people however, the service usually only supported a maximum of four people at a time. This is reflective of current best practice guidance. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. This is reflective of current best practice guidance.
People’s experience of using this service and what we found
People told us they felt safe when they were receiving a respite service at Westminster House. This was also the opinion of relatives we spoke with, who all told us how much people enjoyed attending Westminster House.
People's needs were met in an individual and personalised way by staff who were kind and caring. Independence was promoted, privacy, dignity and people's rights and freedoms were upheld. People were empowered to make their own choices and decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People, or their relatives, were involved in the development of their care plans which were designed to promote people's independence and ensure their needs were known and met by staff. Staff acted in the best interests of the people they supported.
People and their relatives felt listened to and knew how to raise concerns. They, and their relatives told us they would recommend the service to others.
There were enough staff to support people, who had received all necessary training and worked well together. Arrangements were in place to ensure staff received formal and informal supervision from senior staff.
Staff, people and relatives were positive about a new manager who had recently been appointed for the service.
We identified some minor areas for improvement. The manager and senior managers responded promptly and positively taking action where needed.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was Good (published 7 December 2016).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The home was last inspected on 5 and 8 December 2015, when we found three of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breech of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found improvements had been made in these areas.
There was no registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The previous registered manager left the provider in June 2016. Since that time an interim manager who manages one of the providers other homes had been in place at Westminster House. The provider had not commenced recruitment procedures for a new manager and was unable to say when this would occur.
People and their families were positive about the interim manager but were concerned about upcoming reduction in the number of people who could stay at Westminster House. People and their families were worried about access and availability of respite services and were uncertain about their future respite arrangements. The provider had not ensured they were fully involved or informed about the proposals.
Risks to individuals and the environment were pro-actively assessed and managed. Staff were knowledgeable about putting measures in place to reduce risks. Incidents were analysed to identify triggers and causes with measures put in place to reduce the risk and likelihood of reoccurrence.
Peoples’ care plans were person centred and included information about people’s preferences, routines and prompts for staff to support people to maintain their independence. Care plans were reviewed regularly or when people’s needs changed and were developed with people and their families.
Peoples’ medicines were managed safely. A system of auditing and recording was in place to help ensure people received prescribed medicines. People health was monitored and the provider sought advice from health professionals when people required medical assistance.
People’s dietary requirements and preferences were followed. Staff were knowledgeable about people’s individual needs and guidance around people’s specific requirements were clearly displayed in kitchen areas to reduce the risk that they would be not being supported appropriately.
Staff followed legislation designed to protect people’s rights and freedoms. Peoples’ choice, privacy and dignity were respected and upheld.
There were a suitable number of staff working at Westminster House. They had a thorough knowledge of people and cared for them with kindness and compassion. Many staff had worked at Westminster House for a number of years and had formed strong working relationships with people and their families.
The provider had made improvements to ensure a system as in place to support staff through training and supervision. Further improvements were planned where staff would receive an annual performance based appraisal.
Staff were knowledgeable about safeguarding procedures and could identify the steps needed to help to keep people safe if they had concerns. The provider pro-actively displayed and promoted their safeguarding and whistleblowing polices. They were transparent in reporting significant events that happened in the home to relevant professional bodies and people’s families.
People were supported to maintain friendships and access the community whilst staying at Westminster House. People were supported to attend their regular day activities whilst staying. In addition to this, the provider organised day trips out for people. Activities were tailored around people’s likes and preferences and were a good opportunity for people to spend time with their peers.
Auditing and quality assurances processes were in place and resulted in improvements being made to the service and a safe environment for people to stay in.
The provider had a complaints policy in place which was clearly displayed and promoted within the home. People and their families knew how to make a complaint and felt confident their concerns would be listened too.
Westminster House is a care home run by the local authority, which provides short term respite to people with learning disabilities. The home can accommodate a maximum of 10 people and on the days we visited the home, there were four and five people staying respectively. There were a total of 41 people registered to use the respite service, some of whom used it on a weekly basis and others less frequently. The inspection was unannounced and was carried out on the 02 and 08 December 2015.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People were at risk of receiving unsafe or inappropriate care because care records were not always up to date and did not contain sufficient information to inform staff as to people’s individual needs.
Risks relating to people’s care and welfare were not always managed effectively and risk assessments were not up to date.
There was not an effective system in place to manage short term absences, such as staff sickness. Staff were not always supported to develop through supervisions and appraisals.
The registered manager did not always notify CQC, without delay, of incidents of abuse of allegations of abuse affecting people using the service.
Staff sought verbal consent from people before providing care. Staff were knowledgeable about the people they supported and when appropriate followed legislation designed to protect people’s rights and ensure decisions taken on behalf of people were made in their best interests. However, there were no records in people’s care plans to new enable staff to understand the ability of the person to make specific decisions for themselves. We have made a recommendation in respect of this.
We found the home was meeting the requirements of the Deprivation of Liberty Safeguards.
There were systems in place to monitor quality and safety of the service provided. However, some audits were completed on an informal basis and were not recorded. We have made a recommendation in respect of this.
People were supported by staff who had received the appropriate training to enable them to meet their individual needs. There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training.
Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.
Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain their family relationships. People’s families were involved in discussions about their care planning, which reflected their assessed needs.
People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.
Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when speaking with people. Staff were able to understand people and respond to what was being said.
There was an opportunity for families, health professionals and regular visitors to become involved in developing the service and they were encouraged to provide feedback on the service provided. They were also supported to raise complaints should they wish to.
Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of the report.
During this inspection we saw there was now an effective quality assurance process in place which regularly monitored the quality of the service provided. We looked at the results of recently completed feedback questionnaires, including an easy read version for people with learning disabilities. All of the feedback we saw was positive. We also saw there was a staff meeting structure, where staff could raise any issues or concerns and there was an effective complaints procedure which facilitated learning from incidents.
At this inspection we found people's personal records including medical records were accurate and fit for purpose. We spoke with three members of staff who told us they had access to all the necessary information for the provision of care, including policies and procedures.
We observed staff providing care and saw that people looked happy and relaxed. We reviewed six care plans and associated documents. We saw that although the care plans lacked consistency in structure they contained appropriate information about people's care needs and preferences. Most of the plans we looked at contained a series of risk assessments. However, we found some of these had not been updated for a number of years. We spoke with the manager, who was new in post, they told us the care plans were under review and showed us the new format which was in the process of being implemented.
We saw the home was clean and well maintained and there was an effective process in place for dealing with medication. We spoke with four members of staff who told us there was enough staff to meet people's needs. They confirmed they had received appropriate training and had the skills necessary to carry out their duties.
We saw there had been quality assurance systems in place but these had not been maintained and were not current. We also found that some records were not accurately maintained.
We observed staff providing care and saw that people looked happy and relaxed. We reviewed four care plans and associated documents. We saw that although the plans lacked consistency in structure they contained appropriate information about people's care needs and preferences. Most of the plans we looked at contained a series of risk assessments. However, we found no evidence that these had been updated for a number of years.
We spoke with four members of staff and confirmed that they had received appropriate induction training and had the skills necessary to carry out their duties. Staff had received some safeguarding training and were able to say what action they would take if concerns were raised or observed.
We saw that there had been quality assurance systems in place but these had not been maintained and were not current. We spoke with an external community carer and two health professionals, who told us they were happy with the care provided at the home. They said that there was good communication and they were kept informed of changes in people's condition.